Vascular age and arterial stiffness in the assessment of cardiovascular risk among young adults with type 1 diabetes.

Abstract

Abstract Background Cardiovascular risk (CVR) in people with T1DM is assessed using ESC/EASD criteria. However, recent studies have suggested methods that are more accurate for T1DM, such as the Steno Type 1 Risk Engine (ST1RE), vascular age (VA) based on common carotid intima-media thickness (cIMT), and arterial stiffness (AS). We aimed to investigate the association between VA, AS, ST1RE, and ESC/EASD 2019 CVR categories in people with T1DM. Methods The study group comprised T1DM adults aged 18–45 years with a diabetes duration of at least 5 years and without cardiovascular disease. Medical history, anthropometrical features, and laboratory results were collected and used to calculate the 10-year CVR using ST1RE. The cIMT automatic measurement was performed. Based on cIMT, VA was calculated and used instead of chronological age to estimate the modified ST1RE score. We assessed AS by measuring the 24-hour aortic pulse wave velocity (PWV Ao) with a brachial oscillometric device (Arteriograph 24). The participants were divided into 3 CVR categories using ESC/EASD criteria and modified ST1RE scores. Results Sixty-one individuals with a median age of 30.0 (25.0–36.0) years and a diabetes duration of 15.0 (9.0–20.0) years were enrolled. PWV Ao was positively related to VA (Rs = 0.31; p = 0.01) and the modified ST1RE score (Rs = 0.36; p < 0.01). Modified ST1RE categories showed significantly higher agreement (κ = 0.14; p = 0.02) with the ESC/EASD 2019 criteria than the standard ST1RE (κ = 0.00; p = 0.92). The PWV Ao increased with each ESC/EASD 2019 category – 6.62 (6.51–7.32) m/s at moderate risk, 7.50 (7.00–8.05) m/s at high risk, and 8.33 (7.52–9.21) m/s at very high risk (p = 0.02). The multiple logistic regression model revealed that PWV Ao was positively associated with high versus low and moderate CVR based on modified ST1RE (OR = 2.58; 95% CI: 1.04–6.42; p = 0.04). The association was independent of sex, glycated hemoglobin, diabetes duration, the presence of diabetic complications, and BMI. Conclusions Among individuals with T1DM, AS and VA are positively associated with ESC/EASD 2019 criteria and both ST1RE scores. CVR categories based on ST1RE with vascular instead of chronological age have better agreement with the ESC/EASD 2019 criteria.